Development of children born to women abusing cocaine and other drugs in pregnancy is of social, clinical and scientific concern. Current evidence suggests that prenatal exposure affects arousal regulation and attention and may increase vulnerability to the impact of non-optimal caregiving. These findings highlight the importance of understanding the process of development in this group and determining the contribution of Maternal Substance Abuse (MSA) to school age outcomes. Beginning in 1992, the present study investigated the interaction of prenatal drug exposure and postnatal environmental on emotional and social functioning over the first 24 months. Results confirm that both prenatal drug exposure and quality of caregiving are significantly related to autonomic regulation at 8 weeks and behavioral dysregulation at 24 months. Because regulatory disorders at 2 years can predict emotional and social problems at school age as well as adult dysfunction, we will follow a cohort of 200 children and their caregivers into early school-age (7 1/2-years) to evaluate their Behavioral Regulation (Autonomic Arousal Regulation, Emotional Regulation, Social Adaption) Neurocognitive Status and Growth/Health, in relation to: MSA, Caregiving Environment (Caregiving Potential, Quality of Caregiving) and previous Infant Outcomes. We predict that children with prenatal exposure will differ significantly from unexposed children in the same low-SES population in ability to regulate arousal, social perceptions, emotional responses and behavior problems (e.g., aggression) with both prenatal exposure and postnatal caregiving contributing to outcomes. We will also compare their outcomes to those of children in two contrast groups to examine these issues: 1) with a group of prenatally exposed children (n=50), placed in stable homes during infancy, we will compare the moderating effects of environmental stability on behavioral dysregulation; and 2) using a group of children diagnosed with externalizing disorders (n=50) we will compare functioning to those in the MSA group. The results of these studies will provide insight into the impact of factors associated with MSA on school-age outcomes.